paediatric periodontology

Question 1

what BOP score is considered periodontal health

Answer 1

bleeding at less than 10% of sites

Question 2

describe briefly the process of plaque induced gingivitis

Answer 2

• supra-gingival plaque accumulates at gingival margins resulting in inflammatory cell infiltrate building in the gingival connective tissue
• juctional epithelium becomes disrupted leading to the allowance of apical migration of the plaque and a consequential increase in gingival sulcus depth

Question 3

non dental biofilm induced gingival diseases

Answer 3

manifestations of systemic disease or pathological changes limited to gingival tissues
various sub classifications including: infections, traumatic lesions, genetic disorders, neoplasms, drug induced

Question 4

risk factors for necrotising gingivitis

Answer 4

HIV, smoking, malnourishment
also root positioning and malpositioned teeth

Question 5

features of necrotising gingivitis

Answer 5

pain , necrosis of interdental papillae, spontaneous bleeding , ulceration

Question 6

name 3 local (predisposing) risk factors for gingivitis and periodontitis

Answer 6

malocclusion - rotated/instanding teeth
traumatic dental injury - damage to PDL e.g extrusion, intrusion , lateral luxation
dental plaque retention factors - restoration overhangs, orthodontic appliances
incompetent lip seal - oral dryness

Question 7

name 3 systemic (modifying) risk factors for gingivitis and periodontitis

Answer 7

smoking
diabetes
cyclosporin use (immunosuppresant)
nutritional deficiencies

Question 8

name 3 medications that might see gingival overgrowth (hyperplasia)

Answer 8

phenytoin , calcium channel blockers, cyclosporin

Question 9

treatment for gingival overgrowth

Answer 9

rigorous home care
frequent PMPR
possible surgery if genetic or drug induced

Question 10

what are the 4 key features of periodontitis

Answer 10

• apical migration of junctional epithelium beyond the CEJ
• loss of attachment of periodontal tissues to cementum
• transformation of junctional epithelium to pocket epithelium
• alveolar bone loss

Question 11

what pathogens are responsible for periodontitis in children

Answer 11

same as adults
multiple bacteria that include prevotella intermedia, porphyromonas gingivalis, tannerella forsythia

Question 12

staging of periodontitis

Answer 12

based on worst site of interproximal bone loss due to periodontitis
Stage I - less than 15%
stage II - coronal 1/3 root
stage III = mid 1/3 root
stage IV = apical 1/3 root

Question 13

grading of periodontitis

Answer 13

% bone loss divided by age of patient
Grade A = less than 0.5%
Grade B = 0.5-1%
Grade C = > 1%

e.g 42 y/o with 30% bone loss = 0.71% = grade B

Question 14

what are the 3 current statuses periodontitis can be

Answer 14

stable
unstable
remission

Question 15

what 4 things should be included in your diagnosis of periodontitis

Answer 15

stage
grade
current status
risk factors

Question 16

necrotising stomatitis

Answer 16

severe inflammatory condition where necrosis extends beyond gingiva to the soft tissues leading to bone denudation
occurs in severely immunocompromised patients

Question 17

name 3 systemic diseases may manifest as periodontitis in children

Answer 17

downs syndrome
papillon - lefevre syndrome
neutropenias

Question 18

simplified BPE

Answer 18

should be carried out on all co operative children between 7 and 18 years old
20-25g force using WHO 621 probe (single black band)

Question 19

what teeth are investigated during a simplified BPE

Answer 19

16, 11, 26, 36, 31, 46

Question 20

what BPE codes are used in children

Answer 20

children aged 7-11 only codes 0-2
children age 12+ - all codes like an adult

Question 21

SDCEP plaque scores

Answer 21

10/10 - perfectly clean tooth
8/10 - line of plaque around cervical margin
6/10 - cervical 1/3 of crown covered in plaque
4/10 - middle 1/3 of crown covered in plaque

Question 22

what should be done for a sBPE code 0

Answer 22

no periodontal treatment needed
screen again at routine recall appointment or within 1 year (whichever is sooner)

Question 23

what should be done for a sBPE score 1

Answer 23

oral hygiene instruction
screen again at routine recall appointment or within 1 year (whichever is sooner)

Question 24

what should be done for a sBPE score 2

Answer 24

OHI, supra and subgingival PMPR, remove/ manage plaque retention factors
screen at routine recall or within 6 months - whatever is sooner

Question 25

what should be done for a sBPE score 3

Answer 25

OHI, supragingival PMPR, subgingival PMPR in shallow 4-5mm pockets, remove/manage paque retention factors
recall at 3 months for a full perio assesment including 6PPC of affected sextants

Question 26

what should be done for a sBPE code 4

Answer 26

very rare in young patients
full periodontal assessment including 6ppc of entire mouth
referral to specialist